Causes of injuries resulting in hospitalisation in Australia : assessing coder agreement on external causes

Objective: To assess extent of coder agreement for external causes of injury using ICD-10-AM for injury-related hospitalisations in Australian public hospitals. Methods: A random sample of 4850 discharges from 2002 to 2004 was obtained from a stratified random sample of 50 hospitals across four states in Australia. On-site medical record reviews were conducted and external cause codes were assigned blinded to the original coded data. Code agreement levels were grouped into the following agreement categories: block level, 3-character level, 4-character level, 5th-character level, and complete code level. Results: At a broad block level, code agreement was found in over 90% of cases for most mechanisms (eg, transport, fall). Percentage disagreement was 26.0% at the 3-character level; agreement for the complete external cause code was 67.6%. For activity codes, the percentage of disagreement at the 3-character level was 7.3% and agreement for the complete activity code was 68.0%. For place of occurrence codes, the percentage of disagreement at the 4-character level was 22.0%; agreement for the complete place code was 75.4%. Conclusions: With 68% agreement for complete codes and 74% agreement for 3-character codes, as well as variability in agreement levels across different code blocks, place and activity codes, researchers need to be aware of the reliability of their specific data of interest when they wish to undertake trend analyses or case selection for specific causes of interest.

Competitiveness of the Indonesian construction industry

Indonesia’s construction industry is important to the national economy. However, its competitiveness is considered low due to the lack of success of its development strategy and policy. A new approach known as the cluster approach is being used to make strategy and policy in order to develop a stronger, and more competitive industry. This paper discusses the layout of the Indonesian construction cluster and its competitiveness. The archival analysis research approach was used to identify the construction cluster. The analysis was based on the input-output (I/O) tables of the years 1995 and 2000, which were published by the Indonesian Central Bureau of Statistics. The results suggest that the Indonesian construction cluster consists of the industries directly involved in construction as the core, with the other related and supporting industries as the balance. The anatomy of the Indonesian construction cluster permits structural changes to happen within it. These changes depend on policies that regulate the cluster’s constituents

Investigating the links between muscle strength, sun exposure, dietary vitamin D intake and the vitamin D status of ambulatory older adults in South East Queensland

Vitamin D deficiency and insufficiency are now seen as a contemporary health problem in Australia with possible widespread health effects not limited to bone health1. Despite this, the Vitamin D status (measured as serum 25-hydroxyvitamin D (25(OH)D)) of ambulatory adults has been overlooked in this country. Serum 25(OH)D status is especially important among this group as studies have shown a link between Vitamin D and fall risk in older adults2. Limited data also exists on the contributions of sun exposure via ultraviolet radiation and dietary intake to serum 25(OH)D status in this population. The aims of this project were to assess the serum 25(OH)D status of a group of older ambulatory adults in South East Queensland, to assess the association between their serum 25(OH)D status and functional measures as possible indicators of fall risk, obtain data on the sources of Vitamin D in this population and assess whether this intake was related to serum 25(OH)D status and describe sun protection and exposure behaviors in this group and investigate whether a relationship existed between these and serum 25(OH)D status. The collection of this data assists in addressing key gaps identified in the literature with regard to this population group and their Vitamin D status in Australia. A representative convenience sample of participants (N=47) over 55 years of age was recruited for this cross-sectional, exploratory study which was undertaken in December 2007 in south-east Queensland (Brisbane and Sunshine coast). Participants were required to complete a sun exposure questionnaire in addition to a Calcium and Vitamin D food frequency questionnaire. Timed up and go and handgrip dynamometry tests were used to examine functional capacity. Serum 25(OH)D status and blood measures of Calcium, Phosphorus and Albumin were determined through blood tests. The Mean and Median serum 25-Hydroxyvitamin D (25(OH)D) for all participants in this study was 85.8nmol/L (Standard Deviation 29.7nmol/L) and 81.0nmol/L (Range 22-158nmol/L), respectively. Analysis at the bivariate level revealed a statistically significant relationship between serum 25(OH)D status and location, with participants living on the Sunshine Coast having a mean serum 25(OH)D status 21.3nmol/L higher than participants living in Brisbane (p=0.014). While at the descriptive level there was an apparent trend towards higher outdoor exposure and increasing levels of serum 25(OH)D, no statistically significant associations between the sun measures of outdoor exposure, sun protection behaviors and phenotypic characteristics and serum 25(OH)D status were observed. Intake of both Calcium and Vitamin D was low in this sample with sixty-eight (68%) of participants not meeting the Estimated Average Requirements (EAR) for Calcium (Median=771.0mg; Range=218.0-2616.0mg), while eighty-seven (87%) did not meet the Adequate Intake for Vitamin D (Median=4.46ug; Range=0.13-30.0ug). This raises the question of how realistic meeting the new Adequate Intakes for Vitamin D is, when there is such a low level of Vitamin D fortification in this country. However, participants meeting the Adequate Intake (AI) for Vitamin D were observed to have a significantly higher serum 25(OH)D status compared to those not meeting the AI for Vitamin D (p=0.036), showing that meeting the AI for Vitamin D may play a significant role in determining Vitamin D status in this population. By stratifying our data by categories of outdoor exposure time, a trend was observed between increased importance of Vitamin D dietary intake as a possible determinant of serum 25(OH)D status in participants with lower outdoor exposures. While a trend towards higher Timed Up and Go scores in participants with higher 25(OH) D status was seen, this was only significant for females (p=0.014). Handgrip strength showed statistically significant association with serum 25(OH)D status. The high serum 25(OH)D status in our sample almost certainly explains the limited relationship between functional measures and serum 25(OH)D. However, the observation of an association between slower Time Up and Go speeds, and lower serum 25(OH)D levels, even with a small sample size, is significant as slower Timed Up and Go speeds have been associated with increased fall risk in older adults3. Multivariable regression analysis revealed Location as the only significant determinant of serum 25(OH)D status at p=0.014, with trends (p=>0.1) for higher serum 25(OH)D being shown for participants that met the AI for Vitamin D and rated themselves as having a higher health status. The results of this exploratory study show that 93.6% of participants had adequate 25(OH)D status-possibly due to measurement being taken in the summer season and the convenience nature of the sample. However, many participants do not meet their dietary Calcium and Vitamin D requirements, which may indicate inadequate intake of these nutrients in older Australians and a higher risk of osteoporosis. The relationship between serum 25(OH)D and functional measures in this population also requires further study, especially in older adults displaying Vitamin D insufficiency or deficiency.

Who or what decides how stakeholders are optimally engaged by governance networks delivering public outcomes?

As the problems involving infrastructure delivery have become more complex and contentious, there has been an acknowledgement that these problems cannot be resolved by any one body working alone. This understanding has driven multi-sectoral collaboration and has led to an expansion of the set of actors, including stakeholders, who are now involved in delivery of infrastructure projects and services. However, more needs to be understood about how to include stakeholders in these processes and the optimal ways of developing the requisite combination of stakeholders to achieve effective outcomes. This thesis draws on stakeholder theory and governance network theory to obtain insights into how three networks delivering public outcomes within the Roads Alliance in Queensland engage with stakeholders in the delivery of complex and sensitive infrastructure services and projects. New knowledge about stakeholders will be obtained by testing a model of Stakeholder Salience and Engagement which combines and extends the stakeholder identification and salience theory (Mitchell, Agle, and Wood, 1997), ladder of stakeholder management and engagement (Friedman and Miles, 2006) and the model of stakeholder engagement and moral treatment of stakeholders (Greenwood, 2007). By applying this model, the broad research question: “Who or what decides how stakeholders are optimally engaged by governance networks delivering public outcomes?” will be addressed. The case studies will test a theoretical model of stakeholder salience and engagement which links strategic management decisions about stakeholder salience with the quality and quantity of engagement strategies for engaging different types of stakeholders. The outcomes of this research will contribute to and extend stakeholder theory by showing how stakeholder salience impacts on decisions about the types of engagement processes implemented. Governance network theory will be extended by showing how governance networks interact with stakeholders through the concepts of stakeholder salience and engagement. From a practical perspective this research will provide governance networks with an indication of how to optimise engagement with different types of stakeholders.

Staking a claim : the role of stakeholders in government

The stakeholder approach which emerged under the auspices of new public management has been in use in public agencies for the past 25 years. However it remains a difficult and demanding task for agencies to determine who their stakeholders are and how to optimise interactions with them. This paper will examine how government agencies identify, classify and engage with stakeholders who have competing demands, differing access to resources and the ability to exert political pressure. To do this, the stakeholder approaches of nine agencies at three levels of government in Queensland were studied. The contribution of this paper is the development of a Stakeholder Classification Model for Public Agencies which could be used to create more focused and relevant stakeholder interventions.

Learning, language and leadership : conduits to dynamic public service networks

Networks are having a profound impact on the way society is organised at the local, national and international level. Networks are not ‘business as usual’. The defining feature of networks and a key indicator for their success is the strength and quality of the interactions between members. This relational power of networks provides the mechanism to bring together previously dispersed and even competitive entities into a collective venture. Such an operating context demands the ability to work in a more horizontal, relational manner. In addition a social infrastructure must be formed that will support and encourage efforts to become more collaborative. This paper seeks to understand how network members come to know about working in networks, how they work on their relationships and create new meanings about the nature of their linked work. In doing so, it proposes that learning, language and leadership, herein defined as the ‘3Ls’ represent critical mediating aspects for networks.

Inter-agency working : good intentions and interaction dynamics

This paper explores inter-agency working and examines the implications of inter-agency operations for delivering multi-domain service outcomes. Cross-agency collaborative approaches to service delivery are suggested to provide the vehicle for achieving integrated service and policy goals. However, it is argued these need to be crafted ‘fit’ for purpose’ and may not be the requisite approach for all joint purposes. Moreover, some commentators suggest that the optimism about these partnership arrangements and cross-agency actions to resolve complex multi-dimensional problems may be misplaced and propose that further research into the actual rather than desired consequences of these arrangements may find that, at times, partnership working creates negative effects. While collaboration and partnerships are often framed as the way to achieve real breakthroughs in service delivery across agencies, there remain key challenges to interagency working. As more and insistent calls for agencies and other community actors to work together in resolving complex social problems are heeded, the implications of working across organizational boundaries need to be further investigated. This paper investigates cases of inter-agency programmes to understand the dimensions and limitations of inter-agency working. The paper concludes by offering a framework for better inter-agency working that has applicability across all sectors.

Managing infrastructure transitions : a complex adaptive systems perspective

Engineering assets such as roads, rail, bridges and other forms of public works are vital to the effective functioning of societies {Herder, 2006 #128}. Proficient provision of this physical infrastructure is therefore one of the key activities of government {Lædre, 2006 #123}. In order to ensure engineering assets are procured and maintained on behalf of citizens, government needs to devise the appropriate policy and institutional architecture for this purpose. The changing institutional arrangements around the procurement of engineering assets are the focus of this paper. The paper describes and analyses the transition to new, more collaborative forms of procurement arrangements which are becoming increasingly prevalent in Australia and other OECD countries. Such fundamental shifts from competitive to more collaborative approaches to project governance can be viewed as a major transition in procurement system arrangements. In many ways such changes mirror the shift from New Public Management, with its emphasis on the use of market mechanisms to achieve efficiencies {Hood, 1991 #166}, towards more collaborative approaches to service delivery, such as those under network governance arrangements {Keast, 2007 #925}. However, just as traditional forms of procurement in a market context resulted in unexpected outcomes for industry, such as a fragmented industry afflicted by chronic litigation {Dubois, 2002 #9}, the change to more collaborative forms of procurement is unlikely to be a panacea to the problems of procurement, and may well also have unintended consequences. This paper argues that perspectives from complex adaptive systems (CAS) theory can contribute to the theory and practice of managing system transitions. In particular the concept of emergence provides a key theoretical construct to understand the aggregate effect that individual project governance arrangements can have upon the structure of specific industries, which in turn impact individual projects. Emergence is understood here as the macro structure that emerges out of the interaction of agents in the system {Holland, 1998 #100; Tang, 2006 #51}.

The public management issues of access to electronic gaming machines (EGMs) : a case study of policy in Victoria, its effects and requirements for evaluation

Wynne and Schaffer (2003) have highlighted both the strong growth of gambling activity in recent years, and the revenue streams this has generated for governments and communities. Gambling activities and the revenues derived from them have, unsurprisingly, therefore also been seen as a way in which to increase economic development in deprived areas (Jinkner-Lloyd, 1996). Consequently, according to Brown et al (2003), gambling is now a large taxation revenue earner for many western governments, at both federal and state levels, worldwide (for example UK, USA, Australia). In size and importance, the Australian gambling industry in particular has grown significantly over the last three decades, experiencing a fourfold increase in real gambling turnover. There are, however, also concerns expressed about gambling and Electronic Gaming in particular, as illustrated in economic, social and ethical terms in Oddo (1997). There are also spatial aspects to understanding these issues. Marshall’s (1998) study, for example, highlights that benefits from gambling are more likely to accrue at the macro as opposed to the local level, because of centralised tax gathering and spending of tax revenues, whilst localities may suffer from displacement of activities with higher multipliers than the institutions with EGMs that replace them. This also highlights a regional context of costs, where benefits accrue to the centre, but the costs accrue to the regions and localities, as simultaneously resources leave those communities through both the gambling activities themselves (in the form of revenue for the EGM owners), and the government (through taxes).

Managerial effectiveness for a new millennium in the global higher education sector

With the global tertiary education environment undergoing some of the most rapid changes it has experienced since the 1980s, a technology-driven new millennium is requiring an unprecedented capacity for change on a number of fronts, one of these being the way managers manage. This article discusses some of the new realities facing tertiary education organizations, one of which is a realization that "knowledge capital" is the lifeline of an organization. It ultimately vests in the people whom successful organizations will lead, motivate, develop, and value in a manner sensitive to global trends of convergent social, cultural, and organizational change. This article suggests that the effective leadership of people will return as the touchstone for success, the technological age notwithstanding, and notes recent theory on increased reliance upon organizational integrity in the form of value-based policy and practice. This article draws on management and futurist theory to suggest some of the "flexibility imperatives" in managing the potentially different-looking work force of the future.

De-colonising Shakespeare? : Agency and (masculine) authority in Gregory Rogers's The Boy, The Bear, The Baron, The Bard

Underlying social space are territories, lands,geographical domains, the actual geographical underpinnings of the imperial, and also the cultural contest. To think about distant places, to colonize them, to populate or depopulate them: all of this occurs on, about, or because of land. […] Imperialism and the culture associated with it affirm both the primacy of geography and an ideology about control of territory.

Classroom management : developing your own approach to managing the classroom

A recent Australian survey of beginning teachers indicates that issue of classroom management continues to be a key concern for early career educators (Australian Education Union, 2007). This finding is supported by the wider literature that identifies managing the classroom, particularly managing behaviour within the classroom, as critical issues for early career teachers (Arends, 2006; Charles, 2004; Groundwater-Smith, Ewing & Le Cornu, 2007). In fact, struggling to manage student behaviour and maintain positive relationships with students are among the top reasons for teachers leaving the teaching profession (Charles, 2004). So, how does a teacher effectively organise and manage up to thirty students learning and behaviour at any one time? The issue of classroom management is a persistent one for all teachers, but is particularly daunting for new teachers. Historically, classrooms were established on strong hierarchical structures that relied heavily on teacher control and authority. However, more recent approaches to managing the classroom are proactive and more collaborative. That is not to say that there exists a single management recipe, far from it. Beginning teachers must view possible approaches to managing the classroom in light of their own beliefs about teaching and learning, their current classroom practice and variables from the context in which they are teaching.

Workflow simulation for operational decision support

Simulation is widely used as a tool for analyzing business processes but is mostly focused on examining abstract steady-state situations. Such analyses are helpful for the initial design of a business process but are less suitable for operational decision making and continuous improvement. Here we describe a simulation system for operational decision support in the context of workflow management. To do this we exploit not only the workflow’s design, but also use logged data describing the system’s observed historic behavior, and incorporate information extracted about the current state of the workflow. Making use of actual data capturing the current state and historic information allows our simulations to accurately predict potential near-future behaviors for different scenarios. The approach is supported by a practical toolset which combines and extends the workflow management system YAWL and the process mining framework ProM.

Improvements in sustainable energy and water practice in the food processing industry : an in depth analysis of the manufacture of Ghee at the Butter Producers' Cooperative Federation Limited, Brisbane

This thesis is a documented energy audit and long term study of energy and water reduction in a ghee factory. Global production of ghee exceeds 4 million tonnes annually. The factory in this study refines dairy products by non-traditional centrifugal separation and produces 99.9% pure, canned, crystallised Anhydrous Milk Fat (Ghee). Ghee is traditionally made by batch processing methods. The traditional method is less efficient, than centrifugal separation. An in depth systematic investigation was conducted of each item of major equipment including; ammonia refrigeration, a steam boiler, canning equipment, pumps, heat exchangers and compressed air were all fine-tuned. Continuous monitoring of electrical usage showed that not every initiative worked, others had pay back periods of less than a year. In 1994-95 energy consumption was 6,582GJ and in 2003-04 it was 5,552GJ down 16% for a similar output. A significant reduction in water usage was achieved by reducing the airflow in the refrigeration evaporative condensers to match the refrigeration load. Water usage has fallen 68% from18ML in 1994-95 to 5.78ML in 2003-04. The methods reported in this thesis could be applied to other industries, which have similar equipment, and other ghee manufacturers.